The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) Health System Strengthening for Human Capital Development in Eswatini (P168564) AFRICA EAST | Eswatini | Health, Nutrition & Population Global Practice | IBRD/IDA | Investment Project Financing | FY 2020 | Seq No: 1 | ARCHIVED on 28-Sep-2020 | ISR43529 | Implementing Agencies: Kingdom of Eswatini, Ministry of Health Key Dates Key Project Dates Bank Approval Date: 22-Jun-2020 Effectiveness Date: -- Planned Mid Term Review Date: 20-Mar-2023 Actual Mid-Term Review Date: Original Closing Date: 30-Sep-2025 Revised Closing Date: 30-Sep-2025 pdoTable Project Development Objectives Project Development Objective (from Project Appraisal Document) The project development objective is to improve the coverage and quality of key reproductive, maternal, neonatal, child and adolescent health (RMNCAH), nutrition and NCD services (hypertension and diabetes) in Eswatini. Has the Project Development Objective been changed since Board Approval of the Project Objective? No Components Table Name Component 1: Improve health service delivery to increase the coverage and quality of health services to build human capital:(Cost $14.50 M) Component 2. Increase community demand for RMNCAH, nutrition and NCD services:(Cost $2.00 M) Component 3. Strengthen the MOH’s stewardship capacity to manage essential health and nutrition services and project activities:(Cost $3.50 M) Component 4: Contingent Emergency Response Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO -- Satisfactory Overall Implementation Progress (IP) -- Satisfactory Overall Risk Rating -- Moderate Implementation Status and Key Decisions The project was approved by the World Bank Board of Executive Directors on June 22, 2020. Effectiveness is pending, following the due legislative process in the Kingdom of Eswatini, including parliamentary approval, followed by the Royal Assent. The legislative preparatory process is ongoing to attain project effectiveness. The Ministry of Health (MOH) had consultations on the project with stakeholders and beneficiaries and is ready for project implementation, with a Project Operation Manual prepared and a Project Implementation Unit (PIU) in place. To foster cost-efficiency and operational agility, the PIU is integrated in the MOH and serves two health sector lending operations: the COVID-19 Emergency Response Project, effective since April 30, 2020, and this health system operation. 9/28/2020 Page 1 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) The project is part of the broader development agenda to support Eswatini's response to the COVID-19 pandemic and its economic recovery during and post-COVID-19 to foster sustainable development, primarily through strengthening the health system to deliver high quality services to the people and boosting Eswatini's human capital. Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance Substantial -- Substantial Macroeconomic Substantial -- High Sector Strategies and Policies Low -- Low Technical Design of Project or Program Moderate -- Moderate Institutional Capacity for Implementation and Substantial -- Substantial Sustainability Fiduciary Moderate -- Moderate Environment and Social Moderate -- Moderate Stakeholders Moderate -- Moderate Other -- -- -- Overall Moderate -- Moderate Results PDO Indicators by Objectives / Outcomes Improved coverage of key RMNCAH, nutrition and NCD services IN00894589 ►Percentage of patients diagnosed with hypertension and diabetes who are managed at the PHC level (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 80.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of patients (disaggregated by sex) who are diagnosed with hypertension plus number of patients who are diagnosed with diabetes who were managed as per protocol at PHC level Comments: Denominator: Total number of patients (disaggregated by sex) diagnosed with; i) hypertension and ii) diabetes IN00894616 ►Percentage of children under 5 years of age provided with a basic package of nutrition specific services (Percentage, Custom) 9/28/2020 Page 2 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 85.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of children under 5 years (disaggregated by sex) who were provided with basic Comments: package of nutrition services by a community health care worker. Denominator: Total number of children under 5 years (disaggregated by sex) seen by a community health care worker IN00894617 ►Percentage of adolescents served or reached with quality sexual and reproductive health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 70.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of adolescents served or reached with quality sexual and reproductive health services Comments: offered in the target/catchment facilities. Denominator: Total number of adolescents in the population of the target/catchment facilities. Improved quality of RMNCAH, nutrition and NCD services IN00894590 ►Percentage of pregnant women receiving at least 4 ANC visits that meet defined quality standards (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 35.00 60.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of pregnant women seen at a health facility who have four or more ANC visits Comments: recorded that meet defined standards including assessment for high risk pregnancy at each visit Denominator: Total number of pregnant women seen for ANC at a health facility IN00894618 ►Percentage of health facilities that meet a minimum standard of quality as measured by a Health Facility Quality Index (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 80.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of facilities that meet a minimum standard of quality as measured by a Health Facility Quality Index Denominator: Total number of facilities assessed based on the minimum standard of quality Comments: NB: The Health Facility Quality Index is a combined average score from a facility quality of care assessment and the client satisfaction score for the same facility. Baseline will be available in year 2 of the project. Intermediate Results Indicators by Components Improve health service delivery to increase coverage and quality of health services IN00894619 9/28/2020 Page 3 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) ►People who have received essential health, nutrition, and population (HNP) services (Number, Corporate) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 107,882.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 IN00894624 Number of women and children who have received basic nutrition services (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 82,000.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 IN00894627 Number of deliveries attended by skilled health personnel (Number, Corporate Breakdown) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 14,390.00 25,882.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 IN00894628 ►Percentage of women receiving post-partum check-up within 7-14 days (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 84.70 -- 0.00 90.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of women receiving post-partum check-up within 7-14 days after partum. Comments: Denominator: Total number of births IN00894629 ►Number of people screened and diagnosed with hypertension (disaggregated by sex) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 22,160.00 -- 32,335.00 31,230.00 Date 31-Jan-2020 -- 31-Aug-2020 30-May-2025 Numerator: refers to the total number of persons (disaggregated by sex) who were screened and Comments: diagnosed with hypertension Denominator: N/A IN00894630 ►Number of people screened and diagnosed with diabetes (disaggregated by sex) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 1,682.00 -- 7,591.00 8,000.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: refers to the total number of persons (disaggregated by sex) who were screened and Comments: diagnosed with diabetes Denominator: N/A 9/28/2020 Page 4 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) IN00894631 ►Number of HCWs trained to deliver high-quality RMCAH, nutrition and NCD services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 150.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Comments: Numerator: Number of HCWs trained each year under the project (not cumulative) Denominator: N/A IN00894632 ►Number of facilities using eLMIS for supply management (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Comments: Numerator: Number of facilities using eLMIS for supply management Denominator: N/A IN00894633 ►Proportion of health facilities using CMIS for routine reporting (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 54.00 -- 57.00 80.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of health facilities using CMIS for routine reporting Denominator: Total number of Comments: health facilities NB: baseline determined using denominator of 327 health facilities as reported in SARA 2017 IN00894634 ►Percentage of health facilities that have received at least one comprehensive quality assessment applying the appropriate checklist and protocol, and were provided adequate feedback from RHMT (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 90.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of Health facilities that have received at least one comprehensive quality assessment Comments: applying the appropriate checklist and received feedback Denominator: Total number of health facilities that received a comprehensive quality assessment applying the appropriate checklist IN00894635 ►Satisfaction rates of clients with the quality of maternal, child and adolescent health services (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 50.00 -- 50.00 75.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of patients reporting to have been satisfied with health services they received during Comments: a visit to a health facility Denominator: Total number of patients who responded on the patient feedback system 9/28/2020 Page 5 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) Increase community demand for RMNCAH, nutrition and NCD services IN00894620 ►Number of community health workers including RHMs trained to conduct community sensitization & outreach on RMNCAH, Nutrition and NCD services (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 5,000.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Number of community health workers including RHMs trained to conduct community sensitization & Comments: outreach on RMNCAH, Nutrition and NCD services IN00894622 ►Number of mothers and adolescents reached with RMNCAH, Nutrition and NCDs specific communication as part of targeted SBCC interventions (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 82,000.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of mothers and adolescents reached with RMNCAH, Nutrition and NCDs specific Comments: communication as part of targeted SBCC interventions Denominator: N/A IN00894625 ►Number of client-based digital applications’ users (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 41,000.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of client-based digital applications’ users Denominator: N/A NB: Digital application Comments: uptake is assumed at 5% of the reached mothers and adolescents in year one rising to 50% by year 5. Strengthen MOH’s stewardship capacity to manage health & nutrition services and project activities IN00894621 ►Number of updated regulations, policies and strategies for MOH (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 4.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of updated regulations, policies and strategies for MOH Denominator: N/A NB: In Comments: total, about 7 strategic documents will be developed/finalized through resources provided under this project IN00894623 ►Number of MOH staff trained (technical and leadership) (Number, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- 0.00 20.00 9/28/2020 Page 6 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of MOH staff trained (technical and leadership) Denominator: N/A NB: Trainings for Comments: MOH staff are targeting 20 participants in 3 different trainings and most will participate in all three. IN00894626 ►Percentage of health facilities with a protocol to respond to gender-based violence in place (Percentage, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 18.00 -- 18.00 43.00 Date 31-Jan-2020 -- 31-Aug-2020 30-Sep-2025 Numerator: Number of health facilities that have a protocol to respond to gender-based violence in place Comments: Denominator: Total number of health facilities assessed NB: Target is 5% increase annually to be aligned with roll-out plans for NCDs and Nutrition services as well as CMIS Performance-Based Conditions Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed % Disbursed Not P168564 IBRD-91260 USD 20.00 20.00 0.00 0.00 20.00 0% Effective Key Dates (by loan) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P168564 IBRD-91260 22-Jun-2020 -- -- 30-Sep-2025 30-Sep-2025 Effective Cumulative Disbursements 9/28/2020 Page 7 of 8 The World Bank Implementation Status & Results Report Health System Strengthening for Human Capital Development in Eswatini (P168564) PBC Disbursement Achievement Disbursed amount in Disbursement % PBC ID PBC Type Description Coc PBC Amount Status Coc for PBC Restructuring History There has been no restructuring to date. Related Project(s) There are no related projects. 9/28/2020 Page 8 of 8